Organization
RENAL TREATMENT CENTERS SOUTHEAST LP
Active
Other names
North Okaloosa Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
320 REDSTONE AVE W, CRESTVIEW, FL 32536-6433
(850) 683-5700
(850) 683-5704
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4593
(800) 293-5872
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891199100
—
FL
Enumeration date
03/09/2006
Last updated
04/16/2020
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